New England better on primary care than most of US

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PLAINFIELD, Vt. — Ronald Pitkin, 84, remembers the day in the early 1960s when his brother Belmont got a gash in his leg while the two were cutting firewood. They went to the office of the town physician, Frank Corson.

Corson worked alone, and Pitkin was drafted to be assistant. ‘‘He told me ‘You’re going to have to scrub up.’ I was the operating room nurse that day.’’

Now Pitkin gets his care at The Health Center, sleek, modern clinic that houses primary care, dentistry, psychiatry, and other specialties under one roof. It is one of eight facilities in small towns across Vermont that charge based on patients’ ability to pay. They provide primary care to about 25 percent of the mostly rural state’s residents, and experts say they’re a key part of the reason why Vermont leads the country in primary care doctors per capita.

‘‘This is a terrific health care center,’’ Pitkin said recently as he waited for a checkup with thesenior physician, Dr. John Matthew. ‘‘It’s more care, and help in general, for less dollars than just about anywhere.’’

With Vermont leading the way, five of New England’s six states rank in the top six for primary care doctors per capita, according to data from the Association of American Medical Colleges. The sixth, Connecticut, is 12th. With the national shortage of primary care doctors expected to increase after the federal Affordable Care Act takes full effect next year, some are looking to New England states with an eye toward what they have been doing right.

Several factors contribute to New England’s strong position. Among them: public health programs ensuring that high percentages of residents have health coverage, meaning fewer doctors deliver uncompensated care. Massachusetts, which enacted a universal health care program in 2006, has about 97 percent of its residents carrying health coverage. In Vermont it’s about 94 percent.

The high rates of people already insured means ‘‘we will not experience the same [influx of newly insured patients] in Vermont as in other states that have very high rates of uninsured people or low Medicaid eligibility,’’ said Mark Larson, commissioner of the Vermont Department of Health Access.

Medical schools in New England, including the University of Vermont College of Medicine and the University of Massachusetts Medical School, have increased their emphasis on educating doctors for primary care in recent years, officials said. Vermont and New Hampshire augment a federal program that offers partial loan forgiveness for doctors willing to work in underserved areas with a similar state program.

In northern New Hampshire, Edward Shanshala,director of Ammonoosuc Community Health Services, tries to use the lifestyle as a lure recruiting doctors. ‘‘If you like to hike, bike, ski, fish and things like that — great!’’ he said.

Doctors can see more patients because physician’s assistants and nurses deliversome basic care, said Brian Rosman of the Boston-based consumer group Health Care for All.

‘‘The goal is to have everybody working at the top of their license,’’ Rosman said. ‘‘Doctors should do things that really need doctors.’’